Provider Demographics
NPI:1841452364
Name:FRAZIER, MICHAEL KRISTOPHER (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:KRISTOPHER
Last Name:FRAZIER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE
Mailing Address - State:GA
Mailing Address - Zip Code:31079-0247
Mailing Address - Country:US
Mailing Address - Phone:229-365-0056
Mailing Address - Fax:229-365-7737
Practice Address - Street 1:615 2ND AVE
Practice Address - Street 2:
Practice Address - City:ROCHELLE
Practice Address - State:GA
Practice Address - Zip Code:31079-2055
Practice Address - Country:US
Practice Address - Phone:229-365-0056
Practice Address - Fax:229-365-7737
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013710122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist